Provider Demographics
NPI:1912013426
Name:COOKE-THORNTON, VICKY LEIGH (ANP-C)
Entity type:Individual
Prefix:
First Name:VICKY
Middle Name:LEIGH
Last Name:COOKE-THORNTON
Suffix:
Gender:F
Credentials:ANP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 742616
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-2616
Mailing Address - Country:US
Mailing Address - Phone:770-219-8420
Mailing Address - Fax:
Practice Address - Street 1:16825 ROSMAN HWY
Practice Address - Street 2:
Practice Address - City:LAKE TOXAWAY
Practice Address - State:NC
Practice Address - Zip Code:28747-9593
Practice Address - Country:US
Practice Address - Phone:828-862-6900
Practice Address - Fax:000-000-0000
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2025-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC900146363L00000X
TN8150363L00000X
GAGAA-NP002587363L00000X
TNRN1300077363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ090873Medicaid
TN3902922Medicaid
TN4090393OtherBCBS
TN3902922Medicaid